Challenges and Strategies

What are some key challenges to anticipate during the implementation process?

Our consultations with stakeholders experienced in implementing a Housing First program revealed several challenges to anticipate. We organize these challenges into 10 sections: 1- Getting multidisciplinary teams to work together; 2- Working with participants in adjusting to their responsibilities as tenants; 3- Working with landlords in fulfilling their responsibilities as landlords; 4- Supporting participants in the community; 5- Dealing with difficult emotions and burnout in clinical/housing staff; 6- Reorienting program goals; 7- Developing a Housing First philosophy and sense of community; 8- Engaging people with lived experience; 9- Housing and re-housing; and 10- Ensuring Housing First model fidelity. Each section then describes experience-based strategies from stakeholders with Housing First implementation experience, as well as implementation knowledge gained from At Home/Chez Soi.

1: Getting multidisciplinary teams to work together

The separation of housing and clinical services is a key component of the Housing First Model. In some instances, the goals and priorities of these teams might differ and require accommodations. Clinical teams, housing teams and landlords, for example, might have different perspectives and competing goals in the case of a problematic tenancy characterized by disruptive visitors. These differences may lead to teams feeling that they are working in isolation from one another or feeling tension between them. For example, one team (e.g., clinical team) may feel that participants are being re-housed (e.g., by the housing team) without accountability for prior eviction(s), which may make it more difficult for participants to learn from their experiences. It will be important to develop program strategies and protocols to resolve some of these challenges.

What are some strategies for ensuring that the goals of all teams can be effectively met?

1. Avoid blame and acknowledge and embrace differences as well as common purpose/values.

It is important that various stakeholders, including housing and clinical teams avoid blaming each other when challenges arise. Acknowledging the different goals and perspectives of stakeholders is important in developing an atmosphere of effective problem-solving and communication. It is important for teams to “take a step back” and identify the common goals that each team has for participants (i.e., to support participants to maintain stable housing), acknowledge and embrace differing goals, and determine how these differing goals might fit into the larger common goals.

2. Promote ongoing communication between teams.

Stakeholders emphasized communication as the key to ensuring that the goals of all teams can be met effectively. While housing and clinical teams function separately in Housing First implementation, it is essential that these teams remain in regular contact and communication with each other. Having teams housed within the same building or within close vicinity to one another has been an effective strategy in this respect. In addition, ensuring that both teams are present at meetings, where they can see each others’ accomplishments, challenges, and strategies has been an effective strategy.
While housing and clinical teams function separately in Housing First implementation, it is essential that these teams remain in regular contact and communication with each other.
In fact, many stakeholders have suggested having weekly meetings where case managers and housing teams meet together. Including a housing team member in the regular case management team meetings has been effective as well. In the Moncton site of the At Home/Chez Soi project, the rural ACT team would join meetings with the urban ACT team in order to remain “in the loop”. In the Toronto site, both housing and clinical teams participated in joint meetings in order to keep current with each others’ work and to engage in joint problem solving discussions.

3. Develop clear protocols, roles, and responsibilities.

Stakeholders described the importance of developing clear accountability structures, in which different teams and stakeholders can clearly identify their roles and responsibilities, and those from other teams. In addition, developing consistent protocols that can be accessed and referenced by all stakeholders is an effective strategy. For example, having a clear protocol establishing the roles and responsibilities of housing teams versus those of clinical teams, will guide all parties in their respective roles. At the Toronto site of the At Home/Chez Soi project, housing and clinical teams actually developed their protocols together, which encouraged cooperation, sense of ownership, team-building, and clarity. Another example would be having a protocol that describes how to deal with more complex situations (e.g., a challenging tenant-landlord relationship) that is accessible to all stakeholders – landlords, participants, and housing and clinical teams. This will ensure that all stakeholders are clear on program expectations and what their roles are in working toward a resolution.

2: Working with participants in adjusting to their responsibilities as a tenant through the housing/re-housing process

During the implementation process, tensions can arise when stakeholders believe that some participants are having difficulty adjusting adequately to their role as a tenant and are not accountable for being evicted from their housing.

What are some strategies for promoting participants’ accountability for maintaining their housing?

1. Supporting participants from the beginning through basic skills training.

Stakeholders emphasized the importance of having teams work with participants at the beginning of their housing experience, in order to learn basic skills for maintaining a home. Helpful skills, for example, would include: apartment cleaning and maintenance, how to purchase and cook food, how to manage one’s finances, and any other skills that participants would like to learn. One of the stakeholders from the Moncton site of the At Home/Chez Soi project said, “We were cleaning toilets with them. They saw us at the same level as them, not the nurse as being way up high. We were with them doing the same things, and it started a good bond right at the beginning”.

2. Working with participants to reflect and learn.

In order to encourage participant accountability for their choices, it is helpful to see any evictions or potentially negative experiences as a learning process and an opportunity to redirect one’s thoughts and behaviours to make the next housing experience different from the last (for participants and for landlords). For example, some stakeholders suggested that after a first eviction, the worker should sit down with the person to help them reflect on what went wrong, help them develop strategies for avoiding the same thing from happening again (e.g., if it was because they invited the wrong people into their place because they felt isolated or were not able to set boundaries, help them with those issues), and help them reflect on the consequences of what’s happened (e.g., that their range of housing choices may be more restricted because of their actions). Workers can then ask the participant to take on a leadership role in exploring other housing units, while ensuring that they are communicating with the participant in a motivating, supportive manner.

Robert and Teresa were participants of the At Home project. Hear their stories. (NFB)

3: Working with landlords in fulfilling their responsibilities as landlords

During implementation, tensions can arise when stakeholders believe that landlords are having difficulty adjusting adequately to their responsibilities as a landlord. In many instances this challenge will reflect a landlord not acting in accordance with their respective roles and responsibilities as stipulated by provincial law (e.g., the Ontario Residential Tenancies Act in Ontario). The implementation challenge will be to hold both program tenants and landlords accountable to their roles and responsibilities.

What are some strategies for working with landlords in fulfilling their responsibilities as landlords?

1. Educating landlords.

Clinical and housing team members in the At Home/Chez Soi project believed that the role of housing teams is partially that of an educator. They found that being communicative and firm about the legal rights of program tenants was an effective strategy to ensure that landlords fulfilled their responsibilities. Additionally, there was a wide consensus that education on mental health and addictions was very helpful for landlords in being able to better empathize with particular tenants.

There was a wide consensus that education on mental health and addictions was very helpful for landlords in being able to better empathize with particular tenants.

2. Solve problems collaboratively.

In some instances, landlords may simply lack the skills to problem solve. Having events where housing and clinical workers, and other landlords are present to collaboratively problem solve is important. It has been suggested that hosting lunches are an effective way to engage landlords.

4: Supporting participants in the community

In the scatter-site model of housing, participants live in the community, and the team does home visits, often over a wide geographical area. Geographic dispersion can be a challenge for workers, especially for sites implementing Housing First in rural areas or in large urban communities. Living independently (and alone) in the community can also be a challenge for participants, and lead to feelings of isolation and boredom. In addition, there are difficulties associated with getting around in the community without adequate transportation. Finally, another key challenge in helping to supporting participants in the community is ensuring that culturally-informed practices and services are provided for all participants.

What are some experience-based strategies for dealing with doing community-based work when implementing Housing First?

1. Creating positive relationships with program participants.

It is imperative that all stakeholders involved in the process of implementing a Housing First program understand the importance of developing secure and positive relationships with participants.

The following videos demonstrate how transformative these relationships can be for both participants and staff.

2. Create community spaces and other resources for feeling connected.

Multiple stakeholders have described participant feelings of loneliness and boredom when they move away from their community while living on the streets to their own apartment units. They discussed the importance of connecting participants to community resources early on to help curb these experiences of isolation. Some strategies that have helped participants deal with these feelings have included the creation of community drop-in spaces, some of which have been kept open 365 days per year, 7 days per week, 24 hours per day, where participants could speak with case managers (whether their own or not) if they felt lonely. Peer support workers are exceptional resources in facilitating processes around creating community spaces. For example, the Moncton site of the At Home/Chez Soi project had a drop-in centre with services available, as well as phones and computers for people to use. They maintained an open door policy and participants were able to make coffee, socialize, and participate in leisure activities. Hosting weekly, monthly, or annual lunches for participants in order to create sense of community has been suggested as well.

Other helpful strategies may include watching television or listening to the radio as a helpful tool for overcoming early feelings of isolation. It is recommended that teams be proactive in terms of helping participants get their phone and cable connected in order for them to engage in these types of activities.

3. Facilitating connections with participants by mobilizing the resources of the broader community.

Another strategy for staying connected entails finding creative ways of facilitating connections with participants by mobilizing the resources of their broader community. While service teams are still responsible for making a certain number of visits with participants, they can help participants to develop a broader support network. For instance, they can encourage family members of participants to connect regularly with participants and find out if they need any additional support. In addition to team members, family members may help participants with transportation to doctor’s appointments or other meetings that participants would like to attend. Partnering with local pharmacies that agree to deliver medications to participants is another strategy.

4. Be flexible and creative about connecting with participants.

Visiting and trying to get in touch with participants that live far from service team offices (e.g., in rural areas or large urban settings) can be challenging and very time consuming. One strategy for dealing with this challenge is for teams to be creative and flexible in doing the home visits. In large urban communities, it may be helpful to divide the community into catchment areas, and divide service teams so that they are responsible for smaller areas of space, which will decrease transit and driving time. Another suggestion made by stakeholders was to “double-up” on visits. For example, if one worker happened to be planning a visit to a certain client in a particular area, they could also arrange to see another client in that area, even if the original plan was for another worker to make the visit (as long as this is okay with the participant, of course). Providing participants with cell phones so that service-providers and participants can connect with one another would be helpful as well. Finally, it is suggested that home visits decrease in frequency as participant stability increases, as long as participants and workers are both comfortable with this. Instead of going for a house visit, workers and clients have enjoyed meeting for coffee somewhere convenient for both of them.

5. Adapt program implementation to local contexts.

Adapting Housing First implementation to local contexts is important to satisfy varying needs of diverse groups and individuals within diverse settings. For example, Housing First programs implemented in rural settings will often differ from implementation in more urban settings. It is possible to achieve both program fidelity and effective adaptation to local contexts. For example, Housing First was implemented in rural Vermont, where the Pathways Housing First team employed telecommunication strategies to effectively support participants within the community. Another example was in the large urban setting of Toronto, where Housing First was adapted to creatively connect with participants of varying ethno-racial groups. In order to facilitate better access to programs for participants in Winnipeg, services were strategically located within the inner city and other locations where there were large numbers of Aboriginal people.

Protecting the cultural safety of all participants is paramount throughout implementation, especially to create positive relationships with program participants. Culturally-informed practices and services must be provided for participants (e.g., ethnoracial communities and Aboriginal communities). Click here to learn about Winnipeg’s Aboriginal Health and Wellness Centre’s Ni-Apin Intensive Case Management (ICM) team, that adapted housing alternatives based on the cultural needs of Aboriginal participants of the At Home/Chez Soi project, while maintaining high program fidelity.

5: Dealing with difficult emotions and burnout in clinical/housing staff

Throughout program implementation, staff may experience difficult or triggering emotions, as they work very closely with participants and form caring relationships with them. Some staff with lived experience may experience vicarious trauma, which needs to be taken very seriously. Additionally, it is likely that someone will die throughout the program, causing staff members to experience vicarious traumatization.

What are some strategies for dealing with difficult emotions and staff burnout when implementing Housing First?

1. Encourage self-care of staff.

Encourage staff to try and identify when they are experiencing difficult emotions or being triggered by the experiences of participants. Tell staff that self-care is essential and create a work environment that allows staff to engage in self-care measures. For example, include “self-care days”, where staff can leave work early or take time off of work. Encourage staff to ask for help if they need it and emphasize that asking for help does not indicate failure. Keep in mind, as well, that not all clinicians are open to the involvement of peer support workers, so you may want to try to find spaces where peer support workers feel welcome and appreciated. Additionally, some staff with lived experience may experience vicarious trauma, and staff members may experience vicarious traumatization if someone in the program dies. Both formal and/or informal strategies need to be in place to help staff members deal with these experiences and the feelings associated with them. An open-door policy needs to exist for staff to reach out for help, and staff members need to be supported through these experiences. Finally, create an environment of hope and positivity; one that highlights and celebrates even the “small wins” of participants and staff.

Encourage staff to ask for help if they need it and emphasize that asking for help does not indicate failure.

2. Take advantage of team-based case management.

Team-based case management, including team meetings offers a chance for debriefing and problem solving to happen, which facilitates self-care. Stakeholders have found that as they developed their network of community resources, the burden on the individual workers decreased.

Help team members understand that burden on the teams should diminish over time. Team members should anticipate that when teams first start up, because a larger number of new participants come into the program at once, it will likely be a challenging time, before the team gets “over the hump”. The experience in the At Home/Chez Soi project was that as case managers gained confidence and expertise in the model and began to see the benefits to participants, the initial sense of “fragility” of the teams went away and was replaced by a sense of resilience. Even so, stakeholders suggested some strategies for ensuring that this maturing process could happen. For example, it is recommended that when teams are being formed, to be sure to secure a “critical mass” of case managers that had already had some experience with the approach, and ensure there is a proactive strategy in place for training in the case of employee turnover. Key informants also suggested that teams ensure that not too many new participants were brought into the program at once, during the initial start up phase.

6: Reorienting program goals

Consumers will be in different stages of recovery, and experience different challenges throughout the implementation of Housing First programs. Project teams may be working with some participants who are facing substantive challenging with regards to maintaining stable housing and are therefore more focused on meeting their basic needs, while other participants may be moving toward employment and beginning to disengage from the process of requiring continued assistance.

What are some strategies for reorienting program goals when implementing Housing First?

1. Meet participants where they are.

Stakeholders have suggested that teams work with each individual participant at the level that they are at. For example, for one participant who is finding it difficult to meet their basic needs of acquiring food and maintaining housing, it may be unrealistic for them to start thinking about long-term career goals. Another participant, however, may have become experienced in meeting their basic needs and maintaining their home, and therefore, may be ready to engage in the process of obtaining work.

2. Think about alternatives to scatter-site housing.

For people whom the scatter-site model of housing is not working, or for people who do not wish to live in independent housing, begin to think of alternatives or modifications that can be made for particular participants. For example, one of the sites in the At Home/Chez Soi project developed an alternative living arrangement (more of a step-up/step-down facility) for participants who did not feel comfortable living completely on their own.

3. Ensure access to external resources and expertise.

Challenges around how to help people that don’t appear to be improving in their level of stability, or participants with complex needs have arisen throughout the implementation process of the At Home/Chez Soi project.

Make sure you have access to individuals and teams to bring more expertise or a “fresh look” at people with complex needs or who seemingly aren’t getting better. This can be done through consultation with relevant experts/clinicians (e.g., head injury, solvent use, or other serious co-occurring substance use experts).

Additional training will likely be necessary for learning how to deal with complex trauma, such as motivational interviewing strategies, and/or harm-reduction strategies. Furthermore, additional training around difficult tenancy issues (e.g., hoarding, violence, disruptive visitors, or other challenging behavior within housing setting) may be necessary.

MadDogg had a hard time living with others. Now he's a model within the Bosman community. (NFB)

4. Develop innovative, creative job procurement and job maintenance opportunities both within your program and through partnerships, education, and advocacy.

Issues around job procurement and job maintenance have all been discussed during consultation sessions with stakeholders that have implemented Housing First. Being able to envision or create job opportunities for participants where they otherwise would not have existed has been fundamental to Housing First implementation in some communities. In rural communities, for example, search for opportunities around farming projects or selling items at local markets or in connecting with local farmers to participate in farm work. Consider developing job or volunteer opportunities within the Housing First program, including cleaning apartment units for other participants, helping other participants with moving in to their homes, pet-sitting, and other tasks. Facilitate community dinners and hire participants to host and set up the events. Create partnerships within the community, in order to foster vocational opportunities for participants. Educate the community through discussion forums and other events that promote participant involvement and develop ideas around job opportunities. You may want to consider hiring a specialist(s) with a background in vocational assistance to facilitate some of the aforementioned strategies, and can advocate for participants in finding vocational and volunteer opportunities that match their skills and desires.

Creating job opportunities for participants where they otherwise would not have existed has been fundamental to Housing First implementation.

7: Developing a Housing First philosophy and sense of community

With Housing First being a relatively newer model of housing, especially in Canada, challenges can arise with regards to how to create a philosophy that follows the values of the Housing First, and how to build a sense of community among a wide range of stakeholders involved in the implementation process (e.g., health and mental health teams, other support services, consumers, funders, landlords, and peers). For example, some service team members, landlords, and other stakeholders may hold attitudes and philosophical beliefs that are antithetical to Housing First values (e.g., attitudes opposing recovery-orientation or harm-reduction) and can interfere with the atmosphere and sense of community for others associated with the program.

What are some strategies for developing a Housing First philosophy and sense of community when implementing Housing First?

1. Hiring and training processes are key elements of creating team cohesion.

When hiring staff for your project, keep in mind that value orientation is essential to creating a Housing First philosophy. It is essential to hire the “right people”. Staff members should be creative, flexible, compassionate, client-centred problem-solvers that can “think outside the box”. What are staff views on harm reduction and recovery-oriented strategies? How do staff members feel about working in a cohesive team of various stakeholders, rather than working independently? These are some key questions to consider through the hiring process. It is highly recommended to hire people with lived experience, as well as people with diverse perspectives/disciplinary backgrounds. It is also helpful to reassess team members who have not adapted to the Housing First model throughout program implementation evaluations. You might find that you have to change your team in order to ensure that staff members are a good “fit” for implementing a Housing First program.

Multiple stakeholders expressed their gratitude for the training they received prior to implementation of the At Home/Chez Soi project, especially since they were new to the Housing First model. Training needs to include recognition of the difficulty associated with working with participants with complex traumas (e.g., post traumatic stress), and needs to be focused on working with diverse populations, and those experiencing crises. In addition to training, weekly (or daily) team meetings have been helpful for staff members to talk openly, express their frustrations and feelings, and to feel that they are not working alone, but in a cohesive team. Create an institutional space for working through problems collectively, and implementing a “learning as we go” philosophy, where bumps or setbacks along the way are viewed as learning experiences rather than failures. Housing First approaches are team-based and embrace full engagement with participants and other stakeholders who work collectively to achieve positive outcomes. Shared leadership and team structures are integral to creating a cohesive environment.

2. Ensure fidelity to Housing First philosophical principles.

While adapting Housing First programs to local contexts, it is also important that stakeholders make decisions based on Housing First principles and determine if the program is adhering to such principles (discussed later in this module). Continually assess how Housing First principles are being used, and remind all stakeholders about the importance of consumer choice in all aspects of the implementation process, as well as the importance of applying creative and motivational strategies when working with participants. For example, if a person chooses not to engage in treatment, staff is encouraged to hone their skills in harm reduction motivational interviewing, and work with the participant in learning alternative strategies for illness management.

3. Build close relationships with landlords.

Develop strong and close relationships with landlords from the beginning, even prior to program implementation. Be honest with landlords about the challenges that some participants face; don’t share personal information about participants, but provide landlords with an overview of the different types of clients being supported by the program. Emphasize that there will be a strong, cohesive team that will be supporting the participant, and ensure that the team will intervene as needed, to protect the needs of both participants and landlords. A recommendation from a site of the At Home/Chez Soi project is to draw on community agencies that have preexisting relationships with landlords, because they often have an existent stock of available housing units. For example, the Winnipeg site of the At Home/Chez Soi project partnered with their regional health authority that had already established relationships with landlords, and this helped them build relationships with landlords as well. For more detailed information about initiating and sustaining relationships with landlords, click here.

4. Establish clear communication with funders

A critical element of implementation is establishing secure, honest relationships with those funding your Housing First program. Make sure that the funder(s) understand the philosophy and values of the program (e.g., if the funder expects participants to be “housing ready”, they may not be an appropriate match for the program). Spend lots of time, and use creative strategies to go over the program elements, terminology, values, and philosophy with funder(s), and be honest with them from the beginning. Explain that problems should be anticipated, but can be managed effectively through having realistic expectations and engaging in collaborative teamwork.

8: Engaging people with lived experience

The engagement of people with lived experience is imperative to successful implementation of Housing First programs, yet complex to integrate into more traditional housing and clinical environments. It can be challenging to integrate people with lived experience into meaningful roles with housing and clinical teams, as well as to form peer advisory groups. For example, skeptical attitudes of staff, lack of awareness of the benefits of peer involvement, tokenism, and role strain for peers may be challenging. Peer involvement entails, at a minimum, hiring peer support workers, finding mechanisms for getting feedback from participants, and active involvement in Housing First planning, and all subsequent stages of Housing First (see: IMPLEMENT, EVALUATE and SUSTAIN).

What are some strategies for engaging people with lived experience when implementing Housing First?

1. Hiring peer support workers.

Active engagement of peer support workers is integral to successful implementation of Housing First programs. It is essential to recognize that having peer support workers as part of the process in a tokenistic way is undesirable. Peer support workers must be viewed and treated as valuable individuals with knowledge, experience, and abilities about experiences of mental health and/or homelessness that cannot be found elsewhere. Stakeholders have found that hiring peer support workers to work with participants and create social networks for participants to be highly valuable for participants and staff alike. Peer support workers can hold training sessions for service providers to advise them on how to work collaboratively with participants. They can also be part of the collaborative process. For example, involvement of peer support workers in home visits has been found to facilitate more openness and increased engagement of participants in the process. Peer support workers must be hired on a full-time basis, so that they are valued equally to non-peer workers, and to avoid tokenism. To avoid role strain and overburden from multiple role responsibilities of peer support workers, peers should be hired from outside of the program. It may also be helpful to hire peers that are further along in their own recovery, to establish more distance between being a participant and a supporter.

Active engagement of peer support workers is integral to the successful implementation of Housing First programs.

2. Hold debriefing sessions for peer support workers and other staff members.

Peer support work can be challenging in organizational settings that lack inclusive language and power structures, and one in which the inclusion of peer-support workers is new. This can lead to marginalization of peer support workers, as they become excluded from the rest of the team. Additionally, some peer support workers decide to keep their lived experiences private (e.g., in clinical service team settings), which can leave them feeling vulnerable and powerless in certain situations. One strategy to work through these issues would be to hold debriefing sessions (e.g., sharing circles), where peers can discuss ongoing issues they are experiencing and work together to come up with helpful strategies. These sessions can include peer support workers only, or can include other staff members as well, which may lead to breaking down of barriers between staff members.

3. Ensure that processes are in place to elicit feedback about the program from participants.

Involving people with lived experience entails finding ways of ensuring that Housing First program staff understand the experiences of their participants, and develop strategies to elicit their feedback about program strengths and shortcomings. One suggestion from a peer advisor for the At Home/Chez Soi project was to hire a “peer ombudsperson” as a source of objective support for participants if they experience issues around service provision. The peer ombudsperson should have knowledge and experience in homelessness and housing, and should be affiliated with an organization outside of the program being implemented, so that they remain objective.

4. Normalize peer involvement.

Involve peers in all aspects of program implementation, and normalize their presence and involvement. Since peer involvement is rare in more traditional clinical environments, it may take more time for clinicians to understand or experience the benefits of peer involvement. However, when clinicians see that the team is open to and enthusiastic about peer involvement, they may respond more positively.

5. Ensure meaningful involvement of peers.

Peers have a valuable perspective that can greatly aid in implementation and facilitate both buy-in and accountability with program participants. It is important to honor the expertise of peers by giving them full-time stable employment. Additionally, the formation of peer advisory groups is highly recommended, and peer advisory group members should be present at all operations meetings to give their perspectives. One group of peers/participants from the At Home/Chez Soi project came together to form the “Speaker’s Bureau”, as a means to engage other people with lived experience and society at large – a place to connect, discuss, educate, and combat homelessness together.

9: Housing and re-housing

Challenges around housing and rehousing participants, especially when it comes to finding an adequate range of apartments or places that facilitate participant choice, and especially for those who are having more significant difficulty finding housing that adequately fits their needs are common issues in implementing Housing First. It can be a challenge to acquire housing in markets with low vacancy rates and high costs of housing, where the guaranteed income provided by Housing First is likely less of a motivator. When re-housing participants who have been evicted, it is difficult to ensure that evictions do not lead to a poor reputation of the program within the community, or poor reputation of particular participants amongst landlords. Furthermore, it is often especially difficult to rehouse participants who engage in certain activities, such as prostitution, drug use, or dealing drugs. However, re-housing is an important part of participants learning to become tenants and engaged citizens after periods of homelessness. It is important to negotiate re-housing in ways that avoid evictions and maintain positive relationships with landlords wherever possible – particularly in communities where landlords are likely to talk to other landlords about their experiences with tenants.

What are some strategies around housing and rehousing when implementing Housing First?

1. Understand the housing environment and be creative with it.

Know the housing environment within the community that you are working to house participants. Be creative and flexible about the types of housing opportunities that exist but can easily be overlooked. For example, look for family-owned units, where participants may be potential candidates for housing. If a participant is having difficulty finding housing in a particular community, try searching outside of that community for potential options.

2. Carefully consider the fit between the person and the environment.

Stakeholders with Housing First experience emphasized the importance of considering the fit between program participants and housing situations. Participants are more likely to be successful when housing is a good match to their preferences and needs. For example, some stakeholders shared that in rural environments, apartments with fewer tenants worked well for some participants and noted that smaller apartments were easier for individuals with histories of incarceration to manage. Stakeholders explained that focus should be on helping participants become accountable tenants and responsible in managing their apartments.

To ensure a good fit between participants and housing, it is helpful to explore a range of housing types and sizes options. Participant choice of housing tends to focus on both location and the size of the apartment, as well as other factors. Stakeholders shared that some participants preferred small apartments, as they were less overwhelming to maintain. Other participants preferred to live with families and required a bigger space.

3. Hire dedicated, creative staff committed to housing participants.

If there is only one team member devoted to housing, consider hiring another person early on to assist. As mentioned earlier, try to determine the fit needed between a participant and their housing requirements. For example, wheelchair accessibility may be important for one participant, while another participant may prefer to live in an apartment with a vibrant social environment. Matching participant preferences and choices to their housing may prevent eviction and a need for re-housing later on. A stakeholder suggested that to encourage choice, housing teams should try to show participants 2-3 different housing options before the person decides where they want to live. Consider developing a checklist for clients to help them make decisions about what type of housing would be best for them.

4. Keep flexible money available.

According to one site in the At Home/Chez Soi project, having flexible money available for putting things in storage, insurance costs, moving costs, and covering damages in apartment units were integral to keeping people housed.

5. Work with landlords and participants to avoid evictions

Evictions are costly to landlords and difficult experiences for participants. The reality of early implementation is that some tenancies will not work for various reasons. At Home/Chez Soi stakeholders suggested that in many instances landlords were cooperative with housing moves, allowing participants to break their lease in addition to other accommodations. It is important to normalize failed tenancies and evictions and cooperate with all stakeholders to make these experiences as positive as possible.

Now housed, Wolfgang shares his story of homelessness and drug abuse. (NFB)

10: Ensuring Housing First model fidelity

Conducting fidelity assessments to determine if your Housing First program was implemented as intended and ensure that it is adhering to the Housing First principles is essential. Fidelity assessments can be conducted at multiple time points, including earlier in the implementation process and later in the implementation process. Developing an External Quality Assurance team to conduct fidelity assessments to determine if the project showed high fidelity to the Pathways Housing First model was an effective strategy employed by the At Home/Chez Soi project. The Quality Assurance team rated Housing First programs on specific fidelity items (e.g., adherence to Housing First principles of Housing Choice and Structure) based on key informant interviews, consumer focus groups, and participant chart review. Furthermore, based on additional key informant interviews and focus groups, qualitative researchers evaluated factors that helped or hindered the achievement of program implementation and fidelity, as well as stakeholder perceptions of what accounted for fidelity strengths and challenges, lessons learned about the Housing First theory of change, and landlord/caretaker issues. For more detailed information about Housing First fidelity evaluations, click here.